scholarly journals Ankle Fracture Stability-based Classification

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0034
Author(s):  
James Michelson ◽  
John Delaney
Keyword(s):  
Classification System ◽  
Ankle Fracture ◽  
Area Under The Curve ◽  
Positive Outcome ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Kappa Statistics ◽  
Pathologic Fractures ◽  
The Stability ◽  
Excellent Reproducibility

Category: Trauma Introduction/Purpose: Rotational ankle fractures are common in orthopaedic surgery, however existing classification systems are mostly descriptive in nature and do not explicitly guide surgical decision-making. A Stability-Based classification was developed recently to provide a more prognostic classification. The purpose of this study was to compare the reproducibility of existing ankle fracture classifications, and determine the ability of the Stability-Based classification to predict clinical treatment. Methods: One hundred ninety-three consecutive ankle fractures treated at our institution were retrospectively analyzed. Rotational type injury patterns in patients >18 years old were included. None of the subjects were clinically treated or evaluated by the study authors. The fractures were treated by attending physicians who were unaware of the Stability-Based classification system. Pathologic fractures were excluded. Three observers classified injury radiographs using the Lauge-Hansen, Weber/AO, and Stability-Based classifications systems. Reproducibility (inter-observer variation) of each classification system was calculated using kappa statistics. Prognostic values were evaluated by calculating the area under the curve (AUC) for the ROC curves (using surgery as the positive outcome) for each classification. Results: The Stability-Based classification was showed the excellent reproducibility (kappa .938, 95% CI .921-.952), along with the Weber/AO classification (kappa .97, 95% CI .961-.976), while the Lauge-Hansen had the lowest reproducibility (kappa .74, 95%CI .664-.795). The AUC for the three classifications were .883 (95%CI .852-.914), .626 (95%CI .576-.675), and .698 (95%CI .641-.755), respectively (Figure 1). The AUC was significantly better for the Stability-Based classification compared to the other 2 classifications (p<.001). Conclusion: The AO/Weber classification had excellent reproducibility, but did not predict the need for surgical stabilization accurately. In contrast, the Stability-Based classification system was both highly reproducible (kappa .938) with excellent prognostic ability to identify patients who got surgery (AUC .883). Furthermore, there were no patients who were classified as stable who failed non-operative treatment. The Stability-Based classification was found to have superior prognostic capacity compared to both the Lauge-Hansen and AO/Weber classification systems. This extends earlier studies by showing the reproducibility of the Stability-Based classification system and directly demonstrating its prognostic superiority to other classification systems.

Ankle Fracture Classification: A Comparison of Reliability of Three X-ray Views Versus Two

1998 ◽  
Vol 19 (8) ◽  
pp. 555-562 ◽  
Author(s):  
Michael E. Brage ◽  
Matthew Rockett ◽  
Robert Vraney ◽  
Robert Anderson ◽  
Alicia Toledano
Keyword(s):  
Ankle Fracture ◽  
Ankle Injury ◽  
Ankle Fractures ◽  
Kappa Statistics ◽  
Fracture Classification ◽  
X Ray ◽  
Good Accord ◽  
Interexaminer Reliability ◽  
Intraexaminer Reliability ◽  
Good Agreement

Our hypothesis was that malleolar ankle fractures could be classified with two radiographic views as reliably as with three views. Four different observers independently evaluated 99 sets of ankle radiographs. The examiners classified the ankle fractures by using both the Lauge-Hansen and Danis-Weber systems. The interobserver and intraobserver variations were analyzed by kappa statistics. With regard to intraexaminer reliability, the examiners demonstrated excellent accord in classifying the fractures in the Danis-Weber system with either three views or two views. The kappa values were comparable. In the Lauge-Hansen system, three examiners demonstrated excellent accord and one examiner demonstrated good accord in classifying the fractures. Similar kappa values were generated when examiners classified fractures with either three views or two views. With regard to interexaminer reliability, good to excellent accord was demonstrated overall among the four examiners when they used the Danis-Weber system with either three views or two views. The examiners were in good agreement when they used the Lauge-Hansen system. Similar kappa values were generated whether the examiners used three views or two views. Three radiographic views are usually ordered for evaluation of an acute ankle injury. Previous studies have shown that only two views are needed for diagnosis of a malleolar ankle fracture. This study demonstrates that malleolar ankle fractures can be classified with two views, lateral or mortise, with a reliability as good as that achieved with three views. The best agreement is achieved with lateral and mortise views.

scholarly journals Does the quality of preoperative closed reduction of displaced ankle fractures affect wound complications after surgical fixation?

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Bonnie Chien ◽  
Kristen Stupay ◽  
Christopher Miller ◽  
Jeremy Smith ◽  
Jorge Briceno ◽  
...  
Keyword(s):  
Classification System ◽  
Closed Reduction ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Wound Complications ◽  
Complication Rates ◽  
Ankle Osteoarthritis ◽  
Surgical Fixation

Category: Trauma Introduction/Purpose: Prompt reduction and stabilization of displaced ankle fractures is important to protect soft tissues, restore potential neurovascular deficits and prevent cartilage injury. Many of these injuries do eventually require surgical fixation. The purpose of this study is to determine whether the initial quality of ankle closed reduction based on radiographic criteria would affect outcomes such as ankle osteoarthritis and complications after surgery. Furthermore, we sought to develop a classification system for the quality of closed reduction that would be easy to use and provide interrater reliability. Methods: A retrospective analysis of patients who sustained isolated, closed ankle fractures with at least 3 months follow up postoperatively at two level 1 trauma centers was performed. Patient demographics and history, ankle fracture characteristics and reduction information as well as surgical outcomes and complications were collected. A grading classification for the quality of the initial closed reduction before surgery was developed based on standard AP or mortise and lateral ankle x-rays. The factors considered for rating the reduction included the degree of talar shift on the AP/mortise view, malleoli displacement, as well the relationship of a central plumb line to the center of the talar dome on the lateral x-ray. For ankle osteoarthritis, the Takakura classification was utilized. Three reviewers (1 resident, 2 attendings) independently reviewed and rated all imaging. Results: 161 patients were analyzed. 65% female, average age 50, average 4 days between injury and surgery, mean follow up of 12 months (3-58 months), and 17% wound complications. Psychiatric history was the single comorbidity significantly associated with complications (p=0.009). There was no difference in wound or infection complication rates based on initial closed reduction quality (p=0.17). Neither number nor quality of reductions correlated with increased osteoarthritis (p=0.19, 0.39 respectively). Worst graded reductions had shorter time to surgery, mean 1.4 vs 4.7 days for best reductions (p=0.03), suggesting a protective factor that may account for no association between reduction quality and wound complications. Interclass correlation coefficients for multiple observers showed very high consistency for grading of reduction quality based on the classification system (ICC >0.85, p<0.001). Conclusion: It is often emphasized that a displaced ankle fracture should be as perfectly reduced as possible, understandably for grossly dislocated ankle fracture dislocations potentially compromising skin and neurovascular structures. At the same time, this original study demonstrated contrary to common assumption that the initial quality of ankle closed reduction does not appear to affect the severity of ankle osteoarthritis or the rate of surgical complications. This study also developed a highly reproducible ankle reduction classification system. It opens the opportunity for future prospective application and analysis of this classification’s ultimate clinical utility.

scholarly journals Factors influencing functional results after surgery for ankle fractures

2018 ◽  
Vol 1 (2) ◽  
pp. 90-100
Author(s):  
Olivera Lupescu ◽  
Mihail Nagea ◽  
Nicolae-Marian Ciurea ◽  
Alina Grosu ◽  
Alexandru Lisias Dimitriu ◽  
...  
Keyword(s):  
Lower Limb ◽  
Functional Results ◽  
Trauma Centre ◽  
Functional Restoration ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Articular Fractures ◽  
Factors Influencing ◽  
Level 1 ◽  
The Stability

Abstract Ankle fractures are frequent and have a significant impact upon the function of the lower limb, as this joint has a crucial role in standing and especially in walking. Several classification systems have been developed concerning these fractures, connecting the traumatic mechanism to their treatment. Due to their character of articular fractures, functional restoration of local anatomy is necessary; therefore, surgery is mandatory in displaced fractures, affecting the congruency, the stability or the mobility of the ankle joint. The purpose of this paper is to describe the factors influencing the results of surgical treatment in these fractures, as it results from the experience of a level 1 Trauma Centre.

scholarly journals Comparison of the CO-RADS and the RSNA chest CT classification system concerning sensitivity and reliability for the diagnosis of COVID-19 pneumonia

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Mohamed Abdel-Tawab ◽  
Mohammad Abd Alkhalik Basha ◽  
Ibrahim A. I. Mohamed ◽  
Hamdy M. Ibrahim ◽  
Mohamed M. A. Zaitoun ◽  
...  
Keyword(s):  
Classification System ◽  
Intraclass Correlation ◽  
Final Diagnosis ◽  
Chest Ct ◽  
Classification Systems ◽  
Kappa Statistics ◽  
Radiological Society ◽  
Dutch Association ◽  
Ct Classification ◽  
Chest Ct Scan

Abstract Background The Radiological Society of North America (RSNA) recently published a chest CT classification system and Dutch Association for Radiology has announced Coronavirus disease 2019 (COVID-19) reporting and data system (CO-RADS) to provide guidelines to radiologists who interpret chest CT images of patients with suspected COVID-19 pneumonia. This study aimed to compare CO-RADS and RSNA classification with respect to their sensitivity and reliability for diagnosis of COVID-19 pneumonia. Results A retrospective study assessed consecutive CT chest imaging of 359 COVID-19-positive patients. Three experienced radiologists who were aware of the final diagnosis of all patients, independently categorized each patient according to CO-RADS and RSNA classification. RT-PCR test performed within one week of chest CT scan was used as a reference standard for calculating sensitivity of each system. Kappa statistics and intraclass correlation coefficient were used to assess reliability of each system. The study group included 359 patients (180 men, 179 women; mean age, 45 ± 16.9 years). Considering combination of CO-RADS 3, 4 and 5 and combination of typical and indeterminate RSNA categories as positive predictors for COVID-19 diagnosis, the overall sensitivity was the same for both classification systems (72.7%). Applying both systems in moderate and severe/critically ill patients resulted in a significant increase in sensitivity (94.7% and 97.8%, respectively). The overall inter-reviewer agreement was excellent for CO-RADS (κ = 0.801), and good for RSNA classification (κ = 0.781). Conclusion CO-RADS and RSNA chest CT classification systems are comparable in diagnosis of COVID-19 pneumonia with similar sensitivity and reliability.

Evaluation of intersystem agreement between standard pelvic organ prolapse quantification system and simplified pelvic organ prolapse scoring system

2017 ◽  
Vol 6 (5) ◽  
pp. 2031
Author(s):  
Archana G. Singh ◽  
Varsha Rani Choudhary ◽  
Vineeta Ghanghoria ◽  
Kirti Patel
Keyword(s):  
Pelvic Organ Prolapse ◽  
Coming Out ◽  
Classification System ◽  
Staging System ◽  
Weighted Kappa ◽  
Pelvic Organ ◽  
Home Delivery ◽  
Vaginal Wall ◽  
Classification Systems ◽  
Kappa Statistics

Background: Pelvic organ prolapse (POP) is one of the most common gynaecological problem encountered worldwide. The POPQ has become the most commonly used prolapse staging system since its introduction (1996). In spite of having merits to it, POP-Q has not acquired a widespread acceptance. International Urogynaecological Association (IUGA) Standardization of Terminology Committee has devised a simplified version S-POP classification system based on the ordinal stages of the POPQ. The objectives of present study are to determine the intersystem agreement between the standard POPQ and S-POP classification system of pelvic organ prolapse and to propose a user-friendly classification system.Methods: This prospective observational blinded study was conducted in the department of Obstetrics and Gynaecology, NSCB Medical College and Hospital, Jabalpur (M.P.) from March 2015-August 2016. 125 women underwent two separate pelvic examinations POPQ and S-POP, by two groups of gynaecologists at each site. Results were compared and analysed using appropriate statistics.Results: Out of 125 women 54 (43.2%) were in age group 41-50 years. 79 (63.2%) were post-menopausal. 102 (81.4%) were more than third parity. 107 (85.6%) had home delivery. 119 (95.2%) had symptom of something coming out of vagina. The weighted Kappa statistics for the intersystem agreement of S-POP system with POPQ system for overall stage was 0.82, 0.61 for both anterior and posterior vaginal wall, 0.9 for cervix and 0.87 for posterior fornix/cuff.Conclusions: There is significant agreement between the POPQ and S-POP classification systems of POP.

Ankle Fracture Classification Systems: A Case for Integration of the Lauge-Hansen and AO-Danis-Weber Schemes

Foot & Ankle ◽  
1992 ◽  
Vol 13 (7) ◽  
pp. 404-407 ◽  
Author(s):  
Marion C. Harper
Keyword(s):  
Ankle Fracture ◽  
External Rotation ◽  
Classification Systems ◽  
Ankle Fractures ◽  
Fracture Classification ◽  
Relative Simplicity ◽  
Advantages And Disadvantages ◽  
Rotation Pattern ◽  
Fracture Classification Systems ◽  
Pronation External Rotation

The two dominant classification systems for ankle fractures in use are the Lauge-Hansen and AO-Danis-Weber schemes. Each has certain advantages and disadvantages. Because of basic similarities, integration of these systems into one scheme involving three basic patterns with appropriate staging appears to be reasonable. This integration is based upon combining the pronation-abduction and pronation-external rotation injuries in Lauge-Hansen's scheme into one pronation-abduction-external rotation pattern. The resultant system would appear attractive in terms of combining relative simplicity with completeness.

scholarly journals RELIABILITY OF A NOVEL KOCHER CLASSIFICATION FOR OSTEOCHONDRITIS DISSECANS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0026
Author(s):  
Stephen T. Mathew ◽  
Laura A. Lins ◽  
Patricia Miller ◽  
Mininder S. Kocher
Keyword(s):  
Osteochondritis Dissecans ◽  
Classification System ◽  
Treatment Decision ◽  
Classification Systems ◽  
Disease Classification ◽  
Interrater Agreement ◽  
The Novel ◽  
Treatment Decision Making ◽  
The Stability ◽  
Different Characteristics

Background: Current radiographic classification systems for osteochondritis dissecans (OCD) of the knee utilize different characteristics of lesions to rate the stability and severity of disease. Classification systems such as Hefti and Nelson are widely used as the current standards for radiographic imaging and arthroscopic evaluation is the gold standard to assess stability. The purpose of this study was to compare the reliability of this new method with that of older, more established methods, as the first step in establishing its validity and clinical utility. Methods: One hundred twenty-four standardized knee MRIs of established patients with knee OCD were pre-selected to capture the spectrum of lesion types both regarding progression and location of the lesion. Each of the MRIs were classified independently by 2 readers into the Kocher, Hefti, and Nelson classification systems and a random sample was re-reviewed by one rater 6 weeks after initial review. The inter-rater and intra-rater agreement was evaluated by estimating Krippendorff’s alpha. Results: 108 knees were classified by the Kocher, Hefti, and Nelson classification systems, as 16 of the studies had an absence of the appropriate imaging sequences necessary. There were no differences in agreement across classification systems. Krippedorf’s alpha for interrater agreement was 0.51 (CI 0.33-0.66) for the Hefti classification, 0.50 (0.34-0.64) for the Nelson classification, and 0.49 (0.32-0.65) for the Kocher classification. The intrarater agreement was 0.88 (0.75-0.97) for the Hefti classification, 0.94 (0.86-0.99) for the Nelson classification and 0.98 (0.94-1.00) for the Kocher classification system. Conclusions: The novel Kocher classification for knee OCD had almost perfect intrarater agreement and moderate interrater agreement, consistent with well-established classification systems. This new classification system would be simpler with only three categories, whereas the Hefti (five) and Nelson (four) sysems had more. This simpler classification system could be widely applicable because the results could more accurately drive clinical treatment decision making for clinicians.

scholarly journals Toward the Development of a Comprehensive Clinically Oriented Patient Profile: A Systematic Review of the Purpose, Characteristic, and Methodological Quality of Classification Systems of Adult Spinal Deformity

Neurosurgery ◽  
2021 ◽  
Author(s):  
Kenny Yat Hong Kwan ◽  
J Naresh-Babu ◽  
Wilco Jacobs ◽  
Marinus de Kleuver ◽  
David W Polly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Classification System ◽  
Methodological Quality ◽  
Literature Search ◽  
Adult Spinal Deformity ◽  
Classification Systems ◽  
Systematic Literature Search ◽  
Patient Profile

Abstract BACKGROUND Existing adult spinal deformity (ASD) classification systems are based on radiological parameters but management of ASD patients requires a holistic approach. A comprehensive clinically oriented patient profile and classification of ASD that can guide decision-making and correlate with patient outcomes is lacking. OBJECTIVE To perform a systematic review to determine the purpose, characteristic, and methodological quality of classification systems currently used in ASD. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, CINAHL, and Web of Science for literature published between January 2000 and October 2018. From the included studies, list of classification systems, their methodological measurement properties, and correlation with treatment outcomes were analyzed. RESULTS Out of 4470 screened references, 163 were included, and 54 different classification systems for ASD were identified. The most commonly used was the Scoliosis Research Society-Schwab classification system. A total of 35 classifications were based on radiological parameters, and no correlation was found between any classification system levels with patient-related outcomes. Limited evidence of limited quality was available on methodological quality of the classification systems. For studies that reported the data, intraobserver and interobserver reliability were good (kappa = 0.8). CONCLUSION This systematic literature search revealed that current classification systems in clinical use neither include a comprehensive set of dimensions relevant to decision-making nor did they correlate with outcomes. A classification system comprising a core set of patient-related, radiological, and etiological characteristics relevant to the management of ASD is needed.

scholarly journals Management of Ankle Fractures with Syndesmotic Disruption: A Survey of Orthopaedic Surgeons

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0040
Author(s):  
Ryan G. Rogero ◽  
Emmanuel M. Illical ◽  
Daniel Corr ◽  
Steven M. Raikin ◽  
James Krieg ◽  
...  
Keyword(s):  
Gold Standard ◽  
Ankle Fracture ◽  
Management Strategies ◽  
Ankle Fractures ◽  
Multinomial Regression ◽  
Orthopaedic Surgeons ◽  
Suture Button ◽  
Standard Management ◽  
Management Protocol ◽  
Usage Patterns

Category: Ankle; Trauma Introduction/Purpose: With an increasing frequency of syndesmotic fixation during ankle fracture ORIF and no current gold standard management protocol, it is important for surgeons to understand the frequency and usage patterns of the various techniques among other orthopaedic surgeons. The purposes of this study are to determine how orthopaedic surgeons currently manage ankle fractures with concomitant syndesmotic disruption and to identify surgeon demographics predictive of syndesmotic management. Methods: An 18-question survey, including 10 specific syndesmotic management questions was sent to the Orthopaedic Trauma Association (OTA) and Canadian Orthopaedic Association (COA), as well as sent to email addresses of foot and ankle-fellowship trained surgeons. Surgeon demographic questions included years, country, and type of practice, fellowship(s) completed, setting of ankle fracture surgery, and number of ankle fractures operated on per year. Multinomial regression analysis was performed to determine if surgeon demographics were predictive of syndesmotic management. Results: One-hundred ten orthopaedic surgeons completed our survey. Selected predictors of syndesmotic management included: private practice with academic appointments (0.077 [0.007, 0.834]; p=0.035) being predictive of not using screws through an ORIF plate; foot & ankle fellowship (9.981 [1.787, 55.764]; p=0.009) and trauma fellowship (6.644 [1.302, 33.916]; p=0.023) predictive of utilizing screws through a plate; no fellowship (14.886 [1.226, 180.695]; p=0.034) predictive of only using 1 screw; and surgeons practicing in the U.S. were more likely to not use screws across just 3 cortices (0.031 [0.810, 3.660]; p=0.009). Additionally, among those utilizing suture-button devices, foot & ankle fellowship-trained surgeons were more likely to implement suture-button through plate (7.676 [1.286, 45.806]; p=0.025). Conclusion: Several surgeon factors influence decision making in the management of ankle fractures with syndesmotic disruption. This study raises awareness of differences in management strategies that should be used for further discussion when determining a potential gold standard for management of these complex injuries.

scholarly journals Principles and guidelines in the management of ankle fractures in adults

2021 ◽  
pp. 175045892096902
Author(s):  
Harry Kyriacou ◽  
Ahmed MHAM Mostafa ◽  
Benjamin M Davies ◽  
Wasim S Khan
Keyword(s):  
Clinical Guidelines ◽  
Ankle Fracture ◽  
Ankle Fractures ◽  
Recent Developments ◽  
Psychosocial Complications ◽  
British Orthopaedic Association

Ankle fractures are common injuries that have many physical and psychosocial complications. As a result, it is important to be aware of how these patients present and are managed perioperatively. Detailed guidelines from NICE and the British Orthopaedic Association have been produced on this topic, including recent developments such as the decision to weight-bear early after surgery and the use of virtual fracture clinics. This article provides an overview of the key perioperative factors that need to be considered in cases of ankle fracture and the relevant clinical guidelines.

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